Delirium Tremens

Delirium is as state of confusion with impaired quality of consciousness. Delirium is generally typical for older patients who occur in unknown surroundings and usually at night. Delirium tremens or ”shaking delirium” is a special subtype of delirium that is closely related to alcoholism.


Delirium tremens typically occurs in a chronic alcoholic who has for some reason suddenly stopped consuming alcohol. Delirium tremens occurs as a response of the central nervous system to the unexpected alcohol withdrawal. As in the classic delirium, we observe more frequent occurrence of delirium tremens in someone in an unknown surroundings and at night.


Delirium tremens manifests with confusion, i.e. the impaired perception of reality, and tendency to respond aggressively, to feel threatened and to try to escape. Developing delirium tremens is accompanied by hand tremor and hallucinations. The hallucinations have often forms of small animals such as white mice but they can have even much more bizarre appearance. Delirium may last for days and often it disappears within five days after the onset of first signs. Severe forms of delirium tremens may be accompanied by fever, palpitations and other general symptoms.


Muscle tremor, agitation and confusion in a patient with chronic alcoholism in personal history (who has recently stopped drinking) is always highly suspicious of an incoming delirium tremens. The diagnosis can be confirmed by a psychiatric examination.


The patient must be treated pharmacologically. We usually administer larger doses of benzodiazepines or antipsychotic drugs. When this is not possible in form of oral tablets, we use the drugs in form of intramuscular or intravenous injections. Such high doses of medication would put a normal person reliably to sleep but their effect on a delirious patient is much weaker. If it is necessary, limitation by physical means must be done (using straps or belts). We should monitor the patient and his internal environment and ensure adequate hydration and prevent mineral imbalances. 

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources